title: Sharing clinical decisions for multimorbidity case management using social network and open-source tools.
abstract: BACKGROUND
  Social networks applied through Web 2.0 tools have gained importance in health domain, because they produce improvements on the communication and coordination capabilities among health professionals. This is highly relevant for multimorbidity patients care because there is a large number of health professionals in charge of patient care, and this requires to obtain clinical consensus in their decisions. Our objective is to develop a tool for collaborative work among health professionals for multimorbidity patient care. We describe the architecture to incorporate decision support functionalities in a social network tool to enable the adoption of shared decisions among health professionals from different care levels. As part of the first stage of the project, this paper describes the results obtained in a pilot study about acceptance and use of the social network component in our healthcare setting.
  
  
  METHODS
  At Virgen del Rocío University Hospital we have designed and developed the Shared Care Platform (SCP) to provide support in the continuity of care for multimorbidity patients. The SCP has two consecutively developed components: social network component, called Clinical Wall, and Clinical Decision Support (CDS) system. The Clinical Wall contains a record where health professionals are able to debate and define shared decisions. We conducted a pilot study to assess the use and acceptance of the SCP by healthcare professionals through questionnaire based on the theory of the Technology Acceptance Model.
  
  
  RESULTS
  In March 2012 we released and deployed the SCP, but only with the social network component. The pilot project lasted 6 months in the hospital and 2 primary care centers. From March to September 2012 we created 16 records in the Clinical Wall, all with a high priority. A total of 10 professionals took part in the exchange of messages: 3 internists and 7 general practitioners generated 33 messages. 12 of the 16 record (75%) were answered by the destination health professionals. The professionals valued positively all the items in the questionnaire. As part of the SCP, opensource tools for CDS will be incorporated to provide recommendations for medication and problem interactions, as well as to calculate indexes or scales from validated questionnaires. They will receive the patient summary information provided by the regional Electronic Health Record system through a web service with the information defined according to the virtual Medical Record specification.
  
  
  CONCLUSIONS
  Clinical Wall has been developed to allow communication and coordination between the healthcare professionals involved in multimorbidity patient care. Agreed decisions were about coordination for appointment changing, patient conditions, diagnosis tests, and prescription changes and renewal. The application of interoperability standards and open source software can bridge the gap between knowledge and clinical practice, while enabling interoperability and scalability. Open source with the social network encourages adoption and facilitates collaboration. Although the results obtained for use indicators are still not as high as it was expected, based on the promising results obtained in the acceptance questionnaire of SMP, we expect that the new CDS tools will increase the use by the health professionals.
authors.affiliation: Technological Innovation Group, Virgen del Rocío University Hospital, Manuel Siurot Avenue, s/n, 41013 Seville, Spain.
authors.forename: Alicia
authors.initials: A
authors.lastname: Martínez-García
authors.forename: Alberto
authors.initials: A
authors.lastname: Moreno-Conde
authors.forename: Francisco
authors.initials: F
authors.lastname: Jódar-Sánchez
authors.forename: Sandra
authors.initials: S
authors.lastname: Leal
authors.forename: Carlos
authors.initials: C
authors.lastname: Parra
mesh_terms: D000328:Adult; D019090:Case Management; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D012944:Social Support
keywords: ATC; CCD; CDS; COAM; CPC; CSS; Case management; Clinical; DSS; Decision support systems; EHR; ESB; FC; GP; ICD-9; IU; JSF; LOPD; LPPC; Multimorbidity patient; PEU; PU; SCP; SD; SN; SOA; START; STOPP; Social network; TAM; Technology acceptance model; UDB; VRUH; Virgen del Rocío University Hospital; anatomical therapeutic chemical; camas primary care; cascading style sheets; centralized clinical data; centralized operator access module; clinical decision support; decision support service; electronic health record; enterprise service bus; facilitating conditions; general practitioner; intention to use; international classifications of disease 9; java served faces; las palmeritas primary care; perceived ease of use; perceived usefulness; protection of patient data; screening tool of older peoples prescriptions; screening tool to alert doctors to right treatment; service oriented architecture; shared care platform; standard deviation; subjective norm; technology acceptance model; user data base; vMR; virtual medical record